Healthcare Provider Details

I. General information

NPI: 1346301280
Provider Name (Legal Business Name): HEALING PATH HOLISTIC MEDICINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 SE HARRISON ST SUITE B
MILWAUKIE OR
97222-5899
US

IV. Provider business mailing address

3880 SE HARRISON ST SUITE B
MILWAUKIE OR
97222-5899
US

V. Phone/Fax

Practice location:
  • Phone: 503-513-4665
  • Fax: 503-513-4663
Mailing address:
  • Phone: 503-513-4665
  • Fax: 503-513-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00694
License Number StateOR

VIII. Authorized Official

Name: MS. ANJA MIDDELVELD
Title or Position: CO-OWNER
Credential: L.AC.
Phone: 503-513-4665